Sessile serrated lesion detection rates continue to increase: 2008–2020

Abstract

Background and study aims We assessed sessile serrated lesion detection rate (SSLDR) at a large academic medical center from 2008 to 2020 and modeled a local, aspirational target SSLDR. We also assessed SSLDRs among all gastroenterology fellows to better understand the relationship between SSLDRs and total colonoscopies performed. Patients and methods SSL-positive pathology results were flagged from a dataset composed of all screening colonoscopies for average-risk patients from 2008 to 2020. Unadjusted SSLDRs were calculated for individual endoscopists by year. A mixed effects logistic regression was used to estimate the log odds of SSL detection, with one model estimating division-wide predictors of SSL detection and a second model focused exclusively on colonoscopies performed by fellows. Model-adjusted SSLDRs were estimated for all 13 years and across both categories of all endoscopists and fellows only. Results Adjusted SSLDRs showed a consistent improvement in SSLDR from a low of 0.37 % (95 % confidence interval [CI]: 0.10–0.63) in 2008 to a high of 7.94 % (95 % CI: 6.34–9.54) in 2020. Among fellows only, the odds of SSL detection were significantly lower during their first year compared to their second year (OR: 0.80, 95 % CI: 0.66–0.98) but not significantly higher in their third year compared to their second year (OR: 1.09, 95 % CI: 0.85–1.4). Conclusions SSLDR increased steadily and significantly throughout our study period but variance among endoscopists persists. The peak SSLDR from 2020 of 7.94 % should serve as the local aspirational target for this division’s attendings and fellows but should be continuously reevaluated.

Colon polyps: updates in classification and management

“…The SSL detection rates were lowest at the beginning of the study period, 0.37% in 2008 increasing to 7.94% in 2020. SSL detection rate was also found to be lower for first year fellows compared to second and third-year fellows [43]. Such improvement of SSL detection rate over the past two decades based on increased recognition of the serrated polyp pathway to CRC may have contributed to decreasing rates of CRC incidence during this time.…”

Verification of the increase in concomitant dysplasia and cancer with the size of sessile serrated lesions

“…The annual trends were 1.8% in 2015, 2.5% in 2018, and 4.2% in 2022, indicating an upward trend over time. Previous reports have shown that the prevalence of SSLs increased over time [4,5,8]. One possible reason for this increase over time was that the concept of serrated lesions and their recognition as potentially malignant lesions has been disseminated; endoscopists have become more careful in their search for serrated lesions, and the rate at which they resect lesions they recognize has also increased.…”

“…The prevalence of SSL has been reported to vary in recent reports between 2 and 10%. [4][5][6][7][8] A prospective study from Japan indicated that the prevalence of SSL was approximately 5% [9]. The proportion of SSLD and cancer in SSL (SSL-cancer) in patients with SSL has been reported as follows: approximately 5-14% for SSLD and 0.9-1.3% for SSL-cancer [10][11][12].…”

“…The prevalence of SSLs is expected to be increasingly reported compared with that before because the 2019 WHO classification revised the definition of a serrated lesion to be one with ≥ 1 unequivocal architecturally distorted serrated crypt. The prevalence of SSL has been reported to vary in recent reports between 2% and 10% 4 5 6 7 8 . A prospective study from Japan indicated that the prevalence of SSL was approximately 5% 9 .…”

A computer-aided detection system in the everyday setting of diagnostic, screening, and surveillance colonoscopy: an international, randomized trial

“…[6,12,23] This relatively high SDR is not unexpected, given the increasing awareness and recognition of SSLs, as demonstrated by the steady increase of SDR since 2008. [25] Furthermore, in a retrospective analysis of the training and evaluation sets of this CADe system (unpublished results), we found that 11% of the used lesions were diagnosed as SSLs. This relatively large proportion of SSLs in the training set may have contributed to our significant increase in the detection of these notably hard-to-detect lesions.…”